Myxoglobulosis of the appendix presenting as acute appendicitis

Myxoglobulosis is a rare form of appendiceal mucocele characterized by mucoid material inside the appendix that resembles fish eggs. It is usually asymptomatic and diagnosed incidentally, but it can also present as a surgical abdomen, which can create a diagnostic dilemma. This case report presents a 37-year-old male patient with features suggestive of acute appendicitis. A computed tomography scan of the abdomen showed features of appendiceal mucocele. The patient underwent appendicectomy through a lower midline incision. The macroscopic finding was myxoglobulosis, and the patient had an uneventful postoperative course. The histopathology report of the appendix confirmed the diagnosis.

Appendicular mucinous cystadenoma: a case report

Mucinous cystadenoma of the appendix is a rare condition characterized by abnormal mucus accumulation in the appendiceal. Laparoscopic appendectomy is a common approach worldwide and can be used in the management of mucinous cystadenoma with lower postoperative complication rates. A 30-year-old female had sharp pain localized to the right abdomen for 2 days. It was aggravated by movement and associated with nausea and vomiting. Laboratory findings were normal, but the abdominal computerized tomography scan demonstrated a cystic tumor in the right abdomen dorsal to the cecum and the ascending colon. Diagnostic laparoscopy showed a large cystic mass well-circumscribed encapsulated involving the appendix in the lower right abdomen. After demonstrating pathologic examination, the final diagnosis was mucinous cystadenoma of the appendix. Management of the appendicular mucinous cystadenoma can be successfully achieved through atraumatic laparoscopic excision of the tumor, it is safe, feasible and has a short postoperative recovery period.

Single-incision laparoscopic partial cecectomy for appendiceal mucocele in a patient with porphyria photosensitivity

Erythropoietic protoporphyria (EPP) is a rare hereditary subtype of cutaneous porphyria characterized by photosensitivity. Increased exposure to light irradiation may precipitate acute liver failure, and surgical light-induced intestinal burns and perforations are known to occur. We report a case of EPP in a patient who underwent laparoscopic partial cecectomy for appendiceal mucocele. A 55-year-old man with EPP was presented for treatment of appendiceal mucocele. A light test using two types of laparoscopes (Companies O and S) was performed preoperatively. Light from the laparoscope manufactured by Company O caused photosensitivity; this effect was not observed with light from the laparoscope manufactured by Company S. Therefore, we performed laparoscopic partial cecectomy through a single umbilical incision using the laparoscope from Company S. Except for the incision site, the patient's skin was completely covered using surgical drapes. No intra- or postoperative complications were observed. Histopathological examination of the resected specimen revealed a low-grade appendiceal mucinous neoplasm.

Utility of computed tomography and 18 F-fluorodeoxyglucose with positron emission tomography/computed tomography for distinguishing appendiceal mucocele caused by mucinous adenocarcinoma from other pathologies

AIM

Differentiating appendiceal mucocele with mucinous adenocarcinoma from other pathologies before surgery is difficult. The objective of this study was to evaluate the utility of CT and ¹⁸ F-fluorodeoxyglucose (FDG) with positron emission tomography (PET)/CT for differentiating mucinous adenocarcinoma of appendiceal mucocele from other pathologies.

METHOD

The study included 25 patients who underwent surgery for clinically diagnosed appendiceal mucoceles detected on CT at the University of Tokyo Hospital. Among these patients, 19 underwent FDG-PET/CT preoperatively. We compared features of the CT imaging findings and maximum standard uptake values (SUV_max ) detected by FDG-PET/CT between mucocele with mucinous adenocarcinoma and other pathologies.

RESULTS

A total of 13 men (52%) and 12 women (48%) were included in this study, with a median age of 65 years (range 34-83). There were six patients (24%) with pathologically confirmed mucinous adenocarcinoma, 15 patients (60%) with appendiceal mucinous neoplasm and four patients (16%) with simple mucocele caused by chronic inflammation. On the CT findings, wall irregularity was the only significant feature for the two groups in this study (83.3% vs 0.0%, P < 0.01). There was a significant difference in the SUV_max levels on PET/CT between the two groups (100.0% vs 20.0%, P < 0.01).

CONCLUSION

Distinguishing between mucocele with mucinous adenocarcinoma and other pathologies using imaging modalities is challenging. Our results suggest that wall irregularity on CT and elevated SUV_max on PET/CT are useful factors that can be employed for such discrimination.

Minimally invasive surgery for appendiceal intussusception caused by mucocele of the appendix: case report and review of the literature

Appendiceal intussusception caused by mucocele of the appendix is extremely rare. In the current study, a 32-year-old woman was admitted to the department of general surgery of our hospital, complaining of persistent right, lower quadrant pain without an obvious cause for 17 hours. Physical examination indicated significant pain and tenderness in the right, lower abdominal quadrant. Blood analysis indicated that leukocyte count, the percentage of neutrophils and the serum C-reactive protein were increased. Abdominal and pelvic computed tomography revealed a well-encapsulated cystic mass surrounded by the caecum and intussusception. The appendiceal intussusception caused by mucocele of the appendix was revealed during the laparoscopic exploration. Appendectomy and partial cecectomy were conducted using the laparoscopic approach. Postoperative pathological examinations showed ileocecal intussusception and chronic inflammation, appendiceal mucocele and acute suppurative appendicitis. The patient showed satisfactory recovery that was observed during 15-months of follow-ups. This case highlights that laparoscopic appendectomy and partial cecectomy may be a beneficial, minimally invasive approach for appendiceal intussusception caused by mucocele of the appendix.

Mucocele of the appendix presenting as an exacerbated chronic tubo-ovarian abscess: A case report and comprehensive review of the literature

RATIONALE

Appendiceal mucocele is a rare entity of mucinous cystic dilatation of the appendix. It has no typical clinical presentation and is considered a potentially premalignant condition.

PATIENT CONCERNS

We present a case of accidental intraoperative finding of an appendiceal mucocele in a 54-year old woman that clinically presented with an exacerbated chronic tubo-ovarian abscess.

DIAGNOSES

Trans-vaginal ultrasonography showed an encapsulated, oval, unilocular mass above the uterus with a heteroechogenic structure, homogeneous fluid content, and smooth regular walls without inner proliferation. The histopathologic diagnosis was consistent with an appendiceal cystadenoma.

INTERVENTIONS

The patient underwent a simple appendectomy.

OUTCOMES

There were no clinical, biochemical or imaging signs of the disease recurrence at 6 months follow up.

LESSONS

To our knowledge, this is the only well-documented case of appendiceal mucocele mimicking exacerbated chronic tubo-ovarian abscess reported in the literature. Awareness of a rare entity such as an appendiceal mucocele, which is frequently misdiagnosed as a potential cause of acute abdomen, is necessary for the appropriate management strategy in order to prevent complications.

Predicting Underlying Neoplasms in Appendiceal Mucoceles at CT: Focal Versus Diffuse Luminal Dilatation

OBJECTIVE. The purpose of this study was to determine whether a novel morphologic characteristic of appendiceal mucoceles at CT-focal distal appendiceal dilatation with a segment of morphologically normal appendix proximally-could predict an underlying neoplastic pathologic abnormality before surgery and histopathologic assessment. MATERIALS AND METHODS. A retrospective study was performed that assessed CT cases from 2012 through 2014. Cases showing morphologic features of a mucocele were identified and categorized into two subgroups: focal distal dilatation with a segment of normal appendix proximally and generalized appendiceal dilatation. The underlying histopathologic diagnosis for each case was assessed and categorized as neoplastic or nonneoplastic. Several additional morphologic findings were also assessed. RESULTS. Forty-nine cases with confirmed histopathologic diagnoses were identified. Of those, 20 of 23 (87.0%) cases with the finding of focal distal dilatation had an underlying neoplastic cause, whereas 14 of 26 (53.8%) cases with generalized dilatation had an underlying neoplastic cause (p = 0.012). The findings of periappendiceal fat stranding (p = 0.004), mural calcification (p = 0.006), and degree of luminal dilatation (p = 0.002) also reached statistical significance. When seen in combination with focal distal dilatation, the positive predictive value for underlying neoplasm approached or reached 100%. CONCLUSION. Our study shows that isolated focal distal appendiceal dilatation with a segment of morphologically normal appendix proximally is significantly associated with an underlying neoplastic histopathologic cause. When seen in combination with mural calcification, a diameter of more than 2 cm, and absence of periappendiceal stranding, an underlying neoplastic cause is strongly suggested.

Giant appendix or an appendiceal mucocele? Case report of an 11-year-old child

We present an 11-year-old male child with an enormous appendix that was regarded as an appendiceal mucocele. The disorder is very rare and usually appears in middle aged patients. It is a clinical diagnosis. It could cause a variety of symptoms, especially, acute appendicitis and unidentified lesion in the right iliac fossa. According to the reasons, it could be just a curiosity without any relevancy or the sign of a malignant lesion with bad prognostic factors. The histopathological findings prove the origin.

Adult intussusception of appendicular mucinous cystoadenoma

Intussusception is a rare cause of adult intestinal obstruction. Clinical manifestations are not specific, which makes a preoperative diagnosis difficult to establish and often causes delay. We report a case of acute intestinal obstruction due to ileocolic intussusception. An emergency laparoscopy was performed revealing an obstructive mass at the ileocecal region resulting from an appendicular tumor. A right hemicolectomy was conducted. The pathologic examination of the resected sample concluded the mass comprised an appendicular mucinous cystoadenoma. We discuss the clinical features, preoperative diagnosis, and surgical strategies of adult intussusception, as well as the uncommon finding of an appendicular mucinous tumor as its causative lesion, with a review of the available literature.